tbuckley/cabot-search huggingface dataset:
Abstract P638: Sex Differences in Cardiovascular Health Among Young Adults in Puerto Rico
Authors: Cynthia M Perez, Andrea Lopez-Cepero, Israel Almodovar-Rivera, Catarina I Kiefe, Katherine L Tucker, Sharina Person, Jose F Rodriguez-Orengo, Milagros C Rosal
Journal: Circulation (2023)

Background: Emerging evidence supports significant variations in cardiovascular health (CVH), as defined by the American Heart Association (AHA) using “Life’s Simple 7” metrics, among Hispanics in the mainland US by sex and heritage group. Of these, Hispanic men and those of Puerto Rican background are less likely to meet favorable CVH criteria. Yet data on young men and women residing in Puerto Rico, an understudied population with a unique sociocultural context, are scarce. We assessed sex differences in CVH among young adults living in Puerto Rico. Measures: We used PR-OUTLOOK baseline data, collected between September 2020 and September 2022, for this analysis. Participants were between the ages of 18-29 years. CVH was measured using the AHA Life’s Essential 8 (LE8) score, a revised composite metric of physical activity, smoking, diet, sleep, body mass index (BMI), blood pressure, blood glucose, and non-HDL cholesterol. The total score ranges from 0-100, with higher scores indicating better CVH. For this analysis, the measure was modified to exclude diet given the lack of dietary data. Multivariable linear regression models were used to assess sex differences in the overall CVH score and its components. Analyses were adjusted for age, sex, marital status, and childhood material deprivation. Results: The sample included 964 adults - 619 women and 345 men. In adjusted analysis, women had a higher overall CVH score compared to men (β=2.77, 95% CI: 1.10, 4.44). Women also had higher scores for nicotine exposure (β=9.24, 95% CI: 5.18, 13.29), non-HDL cholesterol (β=4.31, 95% CI: 1.11, 7.51), and blood pressure (β=13.22, 95% CI: 10.39, 16.05) but lower for physical activity (β=-9.55, 95% CI: -15.18, -3.91). There were no significant sex differences in scores for sleep health, BMI, and blood glucose. Conclusion: There are sex differences in CVH among young adults in Puerto Rico, with women having overall better CVH. Interventions to improve nicotine exposure, non-HDL cholesterol, and blood pressure in men and participation in physical activity in women are needed to enhance and preserve overall CVH.
Abstract P506: Timing of Cognitive Test Score Decline Before Incident Dementia in Middle Age Adults: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Yunzhi Wang, Josef Coresh, Andrea Schneider, David Knopman, Thomas Mosley, Richey Sharrett
Journal: Circulation (2023)

Background: The most frequent dementias are a mix of Alzheimer’s, vascular and other pathologies which evolve over many years. Our objective is to determine how many years in advance of dementia cognitive scores are affected. Methods: 13,749 dementia-free ARIC participants had a cognitive exam at Visit 2 (1990-1992, mean age 57), 10,813 at Visit 4 (1996-1998), 5,605 at Visit 5 (2011-2013) and 3,516 at Visit 6 (2016-2017). Within 5-year intervals after each visit, we compared the combined mean of three cognitive tests (Delayed Word Recall, Digit Symbol Substitution, and Word Fluency) z-scores at baseline in two groups - participants who were diagnosed with dementia within each interval vs. those who survived to the interval without dementia. Baseline visit z-scores were adjusted for age, gender, race-center and education level in separate linear regression models for each visit. We plotted the adjusted z-score mean [95% confidence interval] by time interval following each visit. Results: Dementia incidence during follow-up yielded 2,981 , 2,397, 961 and 160 cases after Visits 2, 4, 5, and 6 respectively. The three-test combined scores were already significantly lower at 10-15 years before dementia compared to those who did not experience dementia by that period (Figure). As expected at intervals closer to dementia onset the differences between dementia and non-dementia groups increased, up to their widest point of approximately 1 SD at only 0-5 years prior to onset. Delayed Word and Digit Symbol Substitution tests has similar findings while Word Fluency began to decrease only within 5 years prior to dementia onset. Conclusion: We found that the differences in combined cognitive function z-score appeared to be associated with dementia diagnosis as early as 15 years prior to diagnosis. As we got closer to the diagnosis date, the difference in scores of people with and without dementia widened substantially. Periodic testing might allow us to intervene earlier in persons likely to develop dementia.
Abstract P501: Midlife and Late-Life Non-Alcoholic Fatty Liver Disease and Incident Dementia: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Yifei Lu, James R Pike, Ron C Hoogeveen, Keenan Walker, Laura M Raffield, Elizabeth Selvin, Christy L Avery, Michelle M Mielke, Tanya Garcia, Priya Palta
Journal: Circulation (2023)

Introduction: Associations of nonalcoholic fatty liver disease (NAFLD) with dementia are controversial. The full spectrum of NAFLD from simple steatosis to fibrosis has been less investigated. Hypothesis: The severity of NAFLD, especially with the stage of liver fibrosis, is associated with dementia. Methods: The associations between midlife (1990-92, N=9283, mean age 57, female 55%) and late-life (2011-13, N=5138, mean age 75, female 58%) NAFLD and all cause dementia were quantified by Cox regression. NAFLD was characterized using the fatty liver index and liver fibrosis assessment model (FIB-4). Dementia was adjudicated and ascertained through Dec. 31, 2019 from neuropsychological assessments, annual participant or informant contact, and medical record surveillance. We used Cox models with adjustment for demographics, APOE ε4, alcohol, and kidney function. Additional adjustments were made for metabolic factors to explore the independent contribution of NAFLD to dementia. Results: During a median follow-up of 24.5 years after midlife NAFLD assessment, 1854 participants developed dementia. During a median of 6.3 years in late-life, there were 893 dementia cases. A graded increase in dementia risk across the spectrum of NAFLD was observed at midlife (p-trend &lt;0.001), but not at older age ( Figure ). In fact, NAFLD in late-life tended to be protective against dementia. After adjusting for the metabolic factors, the associations remained statistically significant in some categories. Conclusions: Remodeling of hepatic architecture and dysregulation in hepatocellular function in NAFLD at midlife plausibly induce peripheral promoters of neurodegeneration and may expose a large segment of the population to increased risk of dementia. The inverse association of NAFLD with dementia at late-life requires further investigation, possibly reflecting the depletion of susceptibles, the reversibility of NAFLD due to weight loss, and the lack of accuracy in identifying NAFLD using clinical prediction models at older age.
Abstract P503: Association Between Life’s Simple 7 and the Risk of Dementia Among Women
Authors: Pamela M Rist, Melinda C Power, I-Min Lee, Julie E Buring
Journal: Circulation (2023)

Introduction: Given the higher burden of dementia, it is particularly important to identify risk factors for dementia among women. A growing body of research underscores the need to examine midlife risk factors for dementia, as dementia pathology often begins decades before diagnosis. Hypothesis: We hypothesized that higher scores on the AHA Life’s Simple 7 in midlife, indicating better cardiovascular health in midlife, would be associated with a decreased risk of dementia among women followed from middle age into older age. Methods: The study population included women enrolled in the Women’s Health Study who had available risk factor information needed to calculate the AHA Life’s Simple 7 at baseline (1992-1994) and approximately ten years later (2004) and were fully covered by fee-for-service Medicare for all eligible person-months. Women received one point for each component of the Life’s Simple 7 (smoking status, diet, physical activity, body mass index, diabetes, blood cholesterol, and blood pressure) for which they had ideal cardiovascular health. We used fee-for-service Medicare data (available from 2011 through 2018) and validated lists of ICD-9 and ICD-10 codes to identify dementia diagnoses. We used logistic regression to examine the association between the score, modeled as a continuous variable, and dementia diagnosis adjusted for age and socioeconomic status at baseline. Results: A total of 13,720 women were eligible for these analyses and 1771 (12.9%) dementia cases were observed. The mean age (standard deviation (SD)) was 54.2 (6.6) years at baseline. The average Life’s Simple 7 score at baseline was 4.3 (SD=1.3) and after ten years of follow-up was 4.2 (SD=1.3). Higher Life’s Simple 7 score as measured at baseline (odds ratio per one unit change in score=0.94, 95% CI: 0.90-0.98) was associated with a decreased risk of dementia. This effect was similar for the Life’s Simple 7 score as measured after ten years of follow-up (OR=0.95, 95% CI: 0.91-1.00). Conclusions: In this large cohort of women, better cardiovascular health in midlife was associated with a decreased risk of dementia in late life.
Abstract MP05: Prospective Associations of Midlife Physical Activity and Sedentary Behavior With Brain Structure: The Cardia Study
Authors: Kara M Whitaker, Kelley P Gabriel, Annika Helverson, Dong Zhang, Barbara Sternfeld, Stephen Sidney, David R Jacobs, Priya Palta, Kristine Yaffe, Nick Bryan
Journal: Circulation (2023)

Introduction: Strong evidence suggests physical activity may prevent cognitive decline. Less research has explored potential associations of physical activity with brain structure. This is an important research gap given that age related alterations in brain structure are thought to occur prior to signs of cognitive decline. Objective: To determine if accelerometer measured sedentary time (SED), light-intensity physical activity (LPA), and moderate-to-vigorous intensity physical activity (MVPA) at ages 38-50 years are prospectively associated with brain structure. Methods: We studied 562 Black and White men and women enrolled in CARDIA who participated in the 2005-06 exam (baseline) and exams 5 (2010-11) and/or 10 years later (2015-16). SED, LPA, and MVPA were measured by the ActiGraph 7164 accelerometer at baseline. Magnetic resonance imaging (MRI) was used to quantify whole brain, white matter, gray matter, and abnormal tissue volume of white matter at the 5- and/or 10-year follow-up. Compositional isotemporal substitution analysis examined associations of SED, LPA, and MVPA at baseline with repeated measures (unstructured covariance) of MRI measures at follow-up after accounting for intracranial volume and adjusting for confounders ( Table ). Results: Consistent with our hypothesis, substituting 30 minutes of SED to LPA was associated with 0.044% greater total white matter volume (95% CI: 0.001, 0.086). The effect size was larger when substituting SED to MVPA, but this association was not statistically significant. There were no associations observed between accelerometer measures and total brain, total gray matter, or abnormal white matter tissue volumes. Associations did not differ by sex or age. Conclusions: Statistical substitution of time from SED to higher intensity physical activity (LPA or MVPA) was associated with greater total white matter volume. It is unclear why this association was observed in white matter only. Additional research with longer follow-up is needed to confirm these findings.
Abstract MP06: Women but Not Men With a Systolic Blood Pressure Greater the 110mmhg Was Associated With Higher Risk of All-Cause Dementia
Authors: Caiyun Dong, Dongshan Zhu
Journal: Circulation (2023)

Introduction: Whether the association of blood pressure levels and risk of dementia differed by sex remains unclear. Hypothesis: We hypothesized that there might be a sex difference in the association between blood pressure levels and dementia. Methods: We used cohort data from UK Biobank, a large population-based prospective cohort study that recruited 502 649 individuals ages 40-69, between 2006 and 2010. Cox proportional hazards models were used to estimate sex-specific hazard ratios (HRs) and 95% confidence intervals (CI) for the association between blood pressure levels and incident dementia (including all-cause dementia, Alzheimer's Disease (AD), vascular dementia). We conducted subgroup analyses to divide people into two categories of baseline age &lt; 60 years and ≥60 years. Restricted cubic spline models were used to estimate the association between blood pressure levels and all-cause dementia. Results: Overall, 425504 (53.9% women) people with no prevalent dementia were included. After 11.4 (median) years follow-up, 5114 participants (46.2% women) developed dementia. The crude incidence rates were 10.3 for women and 14.0 for men, per 10,000 person-years. The relationship between diastolic blood pressure (DBP) and dementia was U-shaped in both men and women. Women with higher SBP levels were associated with higher risk of all-cause dementia, with an SBP threshold of 110mmhg. Also, women with SBP levels greater than a threshold of 120mmhg and 150mmhg was linked to higher risk of AD and VD, respectively. No relationship between SBP and dementia was observed in men. After the analyses were stratified by age when the SBP was measured (&lt;60 years or ≥60 years), we found that in women younger than 60 years, a nonlinear relationship was observed, i.e., high SBP level greater than 120mmhg was linked to higher risk of all-cause dementia. Conclusions: Women with a threshold of SBP level greater the 110mmhg was associated with higher risk of all-cause dementia, while no such relationship was observed in men.
Abstract P522: Breast Arterial Calcification Predicts Heart Failure Across Racial and Ethnic Groups
Authors: Tara S Allen, Greg M Petersen, Richard Mantey, Junhao Wang, Nitesh Nerlekar, Nora Belrose, Mohammad Eghtedari, Quan M Bui, Lori B Daniels
Journal: Circulation (2023)

Introduction: Breast arterial calcification (BAC), which can be seen on mammograms, is emerging as a risk stratification tool for cardiovascular disease (CVD) outcomes including heart failure, though how prediction varies by race and ethnicity is unknown. Methods: This single-center, retrospective study included 18,092 women age ≥40 years who had a digital mammogram between 2008-2016 and clinical follow-up through 2019. BAC was quantified using an automated algorithm (CureMetrix), resulting in a continuous Bradley score. Heart failure (HF) events and self-reported race and ethnicity were obtained via medical records. Adjusted hazard ratios (aHR) were calculated using Cox proportional hazard regression models with interaction terms to evaluate the effect of race and ethnicity on the association between BAC (presence/absence; or Bradley score quartile among those with BAC) with incident HF, adjusted for age, diabetes, smoking, systolic and diastolic blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and history of CVD and chronic kidney disease. Results: Mean age was 57±11 years with 11,319 (63%) of women White, 907 (5%) Black, 1,694 (9%) Hispanic, 2,321 (13%) Asian, and 1,851 (10%) Other. Over a median follow-up of 3.0 years, 149 of the 4,076 women with BAC (3.7%) developed HF compared to 149 of the 14,016 women without BAC (1.1%). Presence of BAC was associated with incident HF (aHR 1.38, 95% CI 1.21-1.58, p&lt;0.001) overall and among all racial and ethnic groups, with increased risk seen for increasing quartiles of Bradley score (aHR 1.17 in the first, 1.30 in the second, 1.79 in the third, 1.69 in the fourth; p-trend&lt;0.001). The presence of BAC was an even stronger predictor of HF in Black women compared to White women ( Figure ; aHR 1.51 [1.00-2.30], p interaction=0.05). Conclusions: The presence and degree of BAC on a mammogram is an independent predictor of HF and may serve as an especially strong risk factor among Black women.
Abstract P621: Visceral Adipose Tissue Attenuation: A Marker of Liver Fat Content Beyond the Body Mass Index and Visceral Adipose Tissue Area
Authors: Dominic Chartrand, Natalie Almeras, Isabelle Lemieux, Jean-Pierre Despres
Journal: Circulation (2023)

Introduction: Body mass index (BMI) and visceral adiposity cannot fully discriminate individuals at risk of presenting non-alcoholic fatty liver. Discordant visceral adiposity/liver fat phenotypes highlight the need for a better understanding of mechanisms involved in liver fat (LF) accumulation independent of BMI and visceral adipose tissue (VAT) quantity. Hypothesis: As VAT attenuation is a marker of VAT quality, we hypothesized that this marker would be an important determinant of LF accumulation and that a lower VAT attenuation would be associated with an increased LF accumulation irrespective of BMI and VAT area. Methods: Analyses included 3002 participants (51% men) aged 40 to 70 years with BMI values between 18.5 and 40.0 kg/m 2 of INSPIRE ME-IAA, a prospective observational study conducted in 29 countries in America, Asia, and Europe. Computed tomography was used to measure subcutaneous adipose tissue (SAT) and VAT area and attenuation (a marker of adipocyte size) and liver attenuation (a marker of LF content). Participants’ cardiometabolic health profile was assessed in the fasting state. Partial Pearson correlation coefficients were computed to document the associations between VAT area and attenuation and liver attenuation. Multivariable regression analyses were performed to quantify the contribution of SAT and VAT area and attenuation to LF attenuation. A mixed-model ANOVA was used to compare liver attenuation according to VAT area and attenuation, and to compare VAT attenuation according to LF level and VAT area. A generalized linear mixed model was used to compare the prevalence of type 2 diabetes according to LF content and VAT area. Results: VAT attenuation was associated with liver attenuation in women (r=0.34, p&lt;0.0001; r=0.38, p&lt;0.0001; r=0.36, p&lt;0.0001) and men (r=0.42, p&lt;0.0001; r=0.30, p&lt;0.0001; r=0.24, p&lt;0.0001) within each BMI category (normal weight, overweight, obesity), respectively. VAT attenuation better explained LF attenuation than SAT and VAT area. A low VAT attenuation was associated with a lower liver attenuation within each VAT area tertile in all BMI categories (p&lt;0.05). Furthermore, an increased LF content was associated with a lower VAT attenuation (p&lt;0.05) independent of SAT and VAT area in both sexes in all BMI categories. An increased LF content was also associated with a higher prevalence of type 2 diabetes (p&lt;0.05) in individuals with normal weight and overweight beyond VAT area. Conclusion: A low VAT attenuation reflecting larger adipocytes is associated with an increased LF content and risk of type 2 diabetes independent of BMI and VAT area. These results suggest that VAT attenuation as a marker of adipose tissue quality might be involved in the development of non-alcoholic fatty liver disease.
Abstract MP13: Disparities in Home Blood Pressure Monitoring Among Adults Diagnosed With Hypertension Receiving Primary Care in a Large Academic Health System
Authors: Xiaoyue Liu, Cheryl R Dennison Himmelfarb, Cherilyn Hall, Lisa A Cooper, Yvonne Commodore-Mensah
Journal: Circulation (2023)

Background: Uncontrolled hypertension (HTN) remains a major global public health challenge. Home blood pressure monitoring (HBPM) in combination with co-interventions is an effective strategy for managing and controlling HTN. Our objective was to examine disparities in HBPM among patients diagnosed with HTN in an academic health system. Methods: Using a cross-sectional design, we invited patients with an HTN diagnosis in their electronic health record (EHR) and primary care visit in the past 12 months to complete an anonymous online survey through the EHR patient portal. We used logistic regression to examine disparities in self-reported home blood pressure (BP) monitor ownership (yes/no), frequency of HBPM in the past month (&lt; once or ≥ once), and sharing of BP readings with healthcare provider in the past 6 months (yes/no). Results: We recruited 4,181 adult patients; 48%, ≥ 65 years old; 55%, female; 63%, White; 28%, Black; and 4% Asian adults. About 86% owned a home BP monitor. Those who self-identified as Black race (odds ratio [OR] = 0.73, 95% confidence interval [CI]: 0.58-0.91), other race (odds ratio [OR] = 0.62, 95% confidence interval [CI]: 0.41-0.95) and who were unemployed (OR = 0.54, 0.42-0.70) had lower odds of having a home BP monitor than patients who were White adults and were employed, respectively. Adults aged ≥ 65 years had lower odds of checking BP at home ≥ once a month than their counterparts who were &lt; 65 years old (OR = 0.75, 0.62-0.91). Although women (OR = 1.51, 1.29-1.77) and adults who earned &gt; $100,000 (OR = 1.42, 1.11-1.81) were more likely to check their BP in the previous month than men and those earned &lt; $50,000, they (Female: OR = 0.83, 0.71-0.97; Income &gt; $100,000: OR = 0.77, 0.60-0.99) were less likely to share home BP readings with healthcare provider. Conclusions: We observed substantial disparities in HBPM among adults with HTN. Although HBPM has the potential to advance equity in HTN control, factors such as age, race, and socioeconomic status should be considered in the design and implementation of such programs.
Abstract P524: Metabolic Vulnerability and Frailty for Risk Stratification in Heart Failure: A Community Cohort Study
Authors: Sant Kumar, Katie Conners, Jungnam Joo, Sarah Turecamo, Maureen Sampson, Anna T Wolska, Alan T Remaley, Margery Connelly, James D Otvos, Nicholas B Larson, Suzette J Bielinski, Joe Shearer, Veronique L Roger
Journal: Circulation (2023)

Introduction: Over 6 million people in the U.S. have heart failure (HF), less than half are expected to survive beyond 5 years. The need to better stratify mortality risk in HF is recognized. Frailty is associated with mortality in HF but not routinely measured clinically. As frailty is linked to inflammation and malnutrition, we hypothesized that the Metabolic Vulnerability Index (MVX) a multimarker score of systemic inflammation (small HDL particles, GlycA) and malnutrition (leucine, valine, isoleucine, citrate), could serve as a biomarker of frailty to predict mortality risk. Methods: Clinical data and plasma were collected from 1,389 patients from a HF community cohort between 2003-2012. We measured frailty using the Rockwood Index as the proportion of deficits present out of 32 physical limitations and comorbidities. MVX was calculated from the nuclear magnetic resonance LipoProfile® test. Patients were categorized by frailty (0-0.15; 0.16-0.27; 0.28-0.78) and MVX (33.4-50, 50-60, 60-70, 70-85.8) cutpoints. Cox models estimated the association of frailty and MVX assignment with mortality, adjusted for Meta-Analysis Global Group in Chronic HF (MAGGIC) score, a validated clinical risk score for HF mortality. Results: Frailty and MVX scores were available in 985 patients (median age 77, IQR: 67-84; 48% women). Higher frailty was associated with higher MVX (p-trend &lt; 0.001). The highest frailty and MVX groups experienced large increases in risk of death, after adjustment for MAGGIC score (HR=3.3, 95% CI=2.6-4.2) and (HR=2.7, 95% CI=2.1-3.5), respectively. When adjusted for one another and MAGGIC score, MVX and frailty associations with death were only minimally attenuated: frailty (HR=3.2, 95% CI=2.5-4.0) and MVX (HR=2.4, 95% CI=1.9-3.2) (Figure 1). Conclusion: In this community cohort of patients with HF, frailty and MVX are positively associated with one another. However, both indicators are independently associated with an increased risk of death and can contribute to risk stratification.